T.R. Reid’s book: The Healing of America: a global quest for better, cheaper, and fairer health care, is timely material for deliberations of how we might manage to craft a health care system for all the people of our nation — instead of an insurance system for some, and a death sentence for others. Reid’s paramount point is that we need to consider health care for all citizens as a MORAL issue! We need to keep this in mind as we contemplate the rest of his data.

Reid explores at length the health care systems in other countries, including personal experience during periods of residence abroad. He uses the “test case” of seeking physician advice concerning some minor shoulder pain and mobility issues stemming from an ancient injury. Responses are illuminating. Whereas his U.S. physician is quick to suggest an expensive and somewhat risky surgical shoulder replacement, other doctors suggest various alternatives before jumping to surgery. It is no wonder why we have the most expensive health care system by far … along with one of the worst outcomes.

Reid categorizes health care systems into four basic categories, and of course hybrid mixes thereof.

1. There is the Bismarck model, originally from Germany, where regulated private non-profit insurance plans cover everyone, and people visit private physicians. Employers and employees share the premiums. The government assures that those without employment coverage do not fall through the cracks.
2. There is the Beveridge model, originating in post WWII Britain, financed by the government through taxes. The National Health Service is the single payer, with physicians being private, and hosptals nationalized.
3. The National Health Insurance model, a la Canada, is a hybrid of the first two.
4. The Out of Pocket model is the third world model. Those who can afford care get it: others suffer and die.

The U.S. has the craziest health care system: no system! For most of us for-profit insurance companies run the show. Care can vary from Cadillac to nearly worthless, as they play games to minimize “loss” and maximize returns pay shareholders and executives first. We also have the National Health Insurance (Medicare), and the Beveridge model (veterans, TriCare). … We even have the third world Out of Pocket model for the “have-nots.” Ironically, with increasing reliance on high deductible plans, coverage caps, and exclusions: this is effectively what we have even for many who have “insurance!”

Reid’s survey leads me to this conclusion: in every nation that provides effective health care with better outcomes at lower cost than the U.S., the standard care is provided without for profit health insurance. Either the government fulfills those functions as a single payer, or insurers (happily) provide the standard package (and with guaranteed coverage), competing on the “extras” — things like private rooms, super swift payment, … and more spa coverage! Even Switzerland, the supposed citadel of capitalism, wisely converted their system to a not-for-profit insurance basis — ironically at the very time that Clinton’s efforts for reform in the U.S. were being shot down by carpet bombing of “Harry and Louise” commercials in the early 1990s.

When we have for-profit insurance providers (with coverage linked to employment) as a significant portion of our (fragmented) system, there is an irresistible temptation for the insurance companies to aggressively seek to shift costs to someone else, whether that be some government plan (e.g. Medicare, as we age), the insured themself, or the plan from the person’s next employment. In a society where job mobility is accelerating in a breathtaking manner, there is likely to be an opportunity in 2.3 years or so to “dump” any adverse risks. (Then the new insurance company can exclude “pre-existing conditions!”) Needless to say, this risk-shifting scenario provides little incentive for preventive care, in contrast to rational systems where there is a continuity. Whether the provider is a government agency, or not-for-profit insurers with universal coverage, when the payer is in for the long haul, it has an incentive to reduce future costs (and provide better outcomes!) by taking care of the little things – such as preventive medicine. (In Britain, for example, physicians, media, and even signs on buses, encourage people to visit the clinic for their “flu jab,” or other preventive care. In the U.S. the only reason many insurance plans cover any prevention is as public relations or a marketing tool.)

It is also worth noting that in most of these health care systems, the primary care physician is respected as the one who coordinates care and facilitates prevention. This contrasts to the U.S. system where we have 2/3 specialists.

I would recommend that every member of Congress (and those in the Administration) read this book. Then they can refuse the gobs of cash from the Ins Co’s … and maybe craft us a sensible system of health care in the good old U. S. of A.! … Whatever we do we will need universal coverage (the big pool), and a removal of the profit-seeking and cost-shifting motives which distort our current environment to the point of imminent collapse.

Of course, we’ll have to overcome that streak of American exceptionalism whereby we insist upon doing nothing as others have done it, but only as we have “invented.” We didn’t invent the health care anti-system we now have; but we could invent one that uses the best of the experience of others to determine what might give us a real system with effective outcomes at much lower cost.

As we can see, it will be very difficult to change the system due to the financial power of the Insurance-Health complex. It will take true moral courage. Of course, if we fail, we’ll all go broke together!

I read a provocative book recently, Deer Hunting With Jesus, by a guy named Joe Bageant. Joe is one who was born in the hills of the Virginia-West Virginia border area, “escaped” to become a sociologist, and returned. This book, subtitled “Dispatches from America’s Class War,” was published in 2007.

Read this book if you want some insight (through vignettes of Joe’s old friends, neighbors, and acquaintances) into why it can be so hard for the classic “liberals” to enlist people such as those from the Va/WVa border into progressive causes. (Largely, they are just too busy surviving!)

Joe goes into the myriad ways that the established class structure is maintained, quite obvious in these towns and countryside; but also prototypical for the rest of the nation. He also points the finger at the media, complicit in bread and circuses (mostly the later!), and the myths of America (“American Hologram”) that enlist people in a false patriotism.

The blame is not just on the exploiting class, but also on the well-meaning liberals who don’t understand how to communicate with these Scots-Irish descendants and their type.

I almost had to quite reading when I got to the chapter about the American Health System. It described painfully how people, after being milked of their productive energies and exploited by financial rackets, are left to die in sub-standard care facilitities. Ironically, some of these urine-reeking nursing homes were the eagerly received community hospitals in better days, where babies were born and people mended. That was before the profitable “not-for-profit” health care and insurance industries figured out how to squeeze more out of them for their executives and shareholders.

The title comes from the conflation of “down home religion” with gun culture. Joe explains how some of this is related to the frontier experience and the cultural origins of the people who settled here. He mercilessly describes how the rest of us were asleep at the switch while the right wing figured out what buttons to press to enlist these folks into their electoral army.

There’s a heck of a lot more here. One thing I came away with, though, is the importance of education. In many of these places there is a covert conspiracy to keep people dumb so they stay in their “place.” (After all, if the privileged children of the upper class had to compete on a level field with the children otherwise encumbered by poverty and despair, the outcomes might be surprising! Joe includes some stories of potential wasted, as he describes people’s change from friends in his youth to broken down or embittered old age.) People who are functionally illiterate, or not much better, will have trouble exercising their full rights and responsibilities as citizens, instead of merely being consumers and a labor pool.

Joe is a bit pessimistic though most of the stories. He’s only a few years older than I am. I think that good teachers, a little more economic security, and a re-invigorated union movement could work wonders — at least with the next generation!

Guy L. Clifton, M.D. wrote an interesting book about health care in America. The important point he makes is that no matter what system we may devise, ultimately we can’t fix the current crisis without controlling costs.

Clifton’s describes from personal experience (as a neurosurgeon) how most physicians work without any clear notion of what is the most effective standard of care. For example, spinal fusion procedures which are truly effective for a narrow range of cases are used for many inappropriate – to the point of being counter-productive. (Then there are the drug companies, and others who esteem profit inordinately; who are motivated to push their wares onto harried physicians as the cure-all. They also attack consumers through advertising in a manner that used to be considered unethical if not illegal among medical professionals.)

Clifton’s contribution to the discussion is to suggest that we have a Quality Assurance organization/agency which seeks to involve physicians in developing scientifically-based standards for care. He believes that an incredible savings can result.

I picked this book up recently, in the way in which the original “hypertext” steers me from one read to another, and must share briefly.

You may know that I am a strong advocate for the appropriate education of our gifted children, many of whom struggle to move forward in a world where standing out risks being leveled as Alexander the Great sought to level his vassal peoples. You’d think I’d be happy to see the vocational training programs cast aside and things like the new Ohio CORE requirements where all high school graduates in 2014 must have taken Algebra 2, etc.

The truth is, I feel a little queasy about the assumption that all children must attend college — at least as we traditionally see college. … The truth of the matter is that college has become dangerously commodified! Often all the student is doing is just buying a credential (an expensive one at that), and not really learning the critical thinking that is associated with a classic education in the Arts, Sciences, Humanities.

In Shop Class As Soulcraft, Matthew Crawford, takes a look at “An Inquiry into the Value of Work.” Crawford made a pilgrimage from Think Tank to the motorcycle shop, and in this move he gleaned some thoughts pertinent to this subtitle.

Crawford maintains that many of these technical/vocational “craft” type jobs actually do use many of the practitioner’s “higher” faculties, in such procedures as learning how to systematically solve problems – e.g. the skilled mechanic can listen to an engine and learn much (just as the skilled physician used to practice auscultation!). … There’s also the added benefit that many of the repair type crafts cannot be out-sourced!

Is Facebook the AOL (“America On Line”) of the 21st Century? Is Facebook intended to be a sandbox in which one can manage to entertain onesself, without venturing into the great beyond?

I only got on Facebook so I could monitor what my daughter was doing, as she insisted upon using it to connect with her friends. And the tipping factor might have been that her former tap teacher (who she just loves!) is on it after moving far away.

Of course, once exposed to any type of technology, the OSApostle must “figure it out!” So what are my impressions, besides wariness about security concerns?

Facebook in many respects is the AOL of the 21st Century. It seems like much of it is set up to keep people within the Facebook site, even as they view external materials such as blogs and other linked items. The first presentation of any “Link” item is within a frame, with the home still being the Facebook site. Even though one can, after a few clicks, get to the native page; but the default is to keep you on Facebook. The Social RSS application, which can show blog feeds on one’s FB page, also kindly offer to “subscribe” you to the feed — again in a FB-hosted feed reader. (Click on the Blog Name to go directly to feed, where Firefox will offer subscription options. … And if you go to read the article, at least in some settings, you can be take directly to the Blog, and subscribe there via other feed readers, including the commendable ones built into Firefox.)

There is indeed a bewildering array of “Applications.” (All these have their own privacy settings and policies. Aaaargh!!!) If you are using these, you are still on Facebook.

The most frustrating “captive” element, however, is the messaging facility. Do I really want to have to go to Facebook to read my email, when there are many superior programs or web-based solutions available?

As I look at things presently, I notice that the ads are not too thick. That is good, but it makes one wonder how profitable? Perhaps the things like “gifts” for sale help maintain profitability? … Of course, the other not-so-good ways people make money with web properties are:

1. aggregate and sell information
2. sell the whole operation

The first of these seems presently to have some protections in place. But should the second occur, … all bets are off! Of course, then there’s always the “delete” button! (Should it ever come to this, it’s probably best to delete all content before you “Deactivate Account.”)

I’ll continue to experiment with Facebook a bit, but I’m not going to live in the sandbox.

I just looked into Intellectual property concerns regarding Facebook. Before I link posts or or Blog feed there, I want to know: Do I own what I write?

You’d think that it would be obvious that if you write something and post it somewhere, you own it. But it’s not so clear. Many of the sites at least claim a license to “use and display that content” (per Facebook FAQ). Others may actually attempt to assume ownership! Nevertheless, whatever the specific policy, these sites are not charities. They will seek to make some profit, at least by using the attraction presented by your material and that of others to draw more eyes to hosted ads.

Digging deeper in the specific case of Facebook, their “Terms” as of May 1, 2009 at least recognize your ownership of what you post, though warning of the risk that once it’s out of the bag, others may keep copies, etc. and Facebook is not responsible for this.
1. For content that is covered by intellectual property rights, like photos and videos (“IP content”), you specifically give us the following permission, subject to your privacy and application settings: you grant us a non-exclusive, transferable, sub-licensable, royalty-free, worldwide license to use any IP content that you post on or in connection with Facebook (“IP License”). This IP License ends when you delete your IP content or your account (except to the extent your content has been shared with others, and they have not deleted it).

I do appreciate that they cede rights once I delete it!

Also of interest are Facebook’s Privacy policies. Per their warnings, you may want to pay attention to your privacy settings.

Most of Facebook’s information about Intellectual Property and Privacy seems to focus on protecting them from liability for anything a user may choose to do, such as posting copyrighted materials or harassing another user. … It make me wonder if the bill collectors abusing the system might be in violation of Facebook’s policies! Of course, if the sleazeball debt collector “chick” were using her real name it might be legit. But posting anything of questionable veracity or with intent to harass is certainly a violation — of Facebook’s policy as well as of law! There might be some protection in that, though legal recourse could be expensive.

Of course, one needs to keep aware of what would changes might occur in Facebook policies should they be acquired.

Security provisions for Facebook “Applications” might also be something to look out for. Check those privacy settings and terms. It still seems to me that the Facebook interface is a bit kludgy with regard to finding and controlling all of these settings. It is worth a little time to explore it if you intend to make much use of Facebook.

I had been meaning to post some reflections on Facebook and security, among other things. I am inherently cautious about what one should put “out there” in cyberspace.

Then I saw this article on Alternet, and thought it deserved immediate special mention:
Is Your Newest Facebook Friend a Sleazeball Debt Collector? The Alternet article has a lot to say about the debt collection and debt settlement industries in general, as well as some particulars about abuse of social media.

One new scheme is to have an attractive young lady ask to become your “friend,” so that those behind the facade may gain access to all the juicy personal information you post on Facebook. Then they can know of other ways to contact you, what you are up to — maybe even when you are home or not at home. (Burglars prefer the later.) The part most relevant to Facebook points to another article: Debt Collectors Using Cute Chicks On Facebook As Bait.

The Alternet article tells how debt collectors have used Facebook or other social media sites to post embarrassing information — and not always truthful information. There are several lawsuits now in the works from people who have been victims of this abuse.

So, please be careful what you put on social media sites. Think about when it is more appropriate to use personal email to communicate. (And you might even think of using encryption!)

Another gem from the Public Education Network Weekly NewsBlast. The football version of what is going on in education right now.

For all educators in and out of the education system:

1. All teams must make the state playoffs and all MUST win the championship. If a team does not win the championship, they will be on probation until they are the champions, and coaches will be held accountable. If after two years they have not won the championship their footballs and equipment will be taken away UNTIL they do win the championship.
2. All kids will be expected to have the same football skills at the same time, even if they do not have the same conditions or opportunities to practice on their own. NO exceptions will be made for lack of interest in football, a desire to perform athletically, or genetic abilities or disabilities of themselves or their parents. ALL KIDS WILL PLAY FOOTBALL AT A PROFICIENT LEVEL!
3. Talented players will be asked to workout on their own, without instruction. This is because the coaches will be using all their instructional time with the athletes who aren’t interested in football, have limited athletic ability or whose parents don’t like football.
4. Games will be played year round, but statistics will only be kept in the 3rd, 5th, 8th, and 11th game. This will create a New Age of Sports where every school is expected to have the same level of talent and all teams will reach the same minimum goals. If no child gets ahead, then no child gets left behind. If parents do not like this new law, they are encouraged to vote for vouchers and support private schools that can screen out the non-athletes and prevent their children from having to go to school with bad football players.

I found this in the Public Education Network Weekly NewsBlast

“Not on the Test” satirizes the American education system’s renewed focus on rote teaching.

Tom Chapin, a Grammy Award-winning musician perhaps best known for children’s music, has released a new song titled “Not on the Test.” The song satirizes the American education system’s renewed focus on rote teaching, in which tests have become the sole reason to teach and learn. Music, art, drama and sports were what kept Chapin engaged in school. In addition, these subjects make the teacher’s (and the student’s) job easier and infinitely more rewarding. Unfortunately, they are also what have been cut from curriculums across the country as Chapin explains lightheartedly in song.

Chapin’s web site for “Not on the Test” has helpful links and information, including audio, video, lyrics, and art. Tom Chapin’s Official Web Site also features “Not on the Test.”

As one concerned that budget cuts will eviscerate a good education, I resonate and recommend.